Part of the mission of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), one of the 27 Institutes and Centers at the National Institutes of Health (NIH), is "to ensure that every person is born healthy and wanted, that women suffer no harmful effects from reproductive processes, and that all children have the chance to achieve their full potential for healthy and productive lives..."

Preeclampsia is one of the serious public health problems on which the NICHD has focused more closely over the last decade, spurred on by increasingly sobering statistics. Between 2006 and 2010, more than 9 percent of pregnancy-related deaths in the United States resulted from "hypertensive disorders of pregnancy, including preeclampsia,"
according to the Centers for Disease Control and Prevention (CDC), and in 2009, more than 4 percent (41.2 per 1,000) of all women giving birth were reported to have gestational or pregnancy-related hypertension (including preeclampsia), a 50 percent rise since 1990 (CDC).

In 2007, NICHD published Preeclampsia-a pressing problem: An executive summary of an NICHD workshop reviewing the research gaps and future research pathways identified during its 2006 workshop. (Editor's Note: the Preeclampsia Foundation participated in that workshop and the resulting publication.) Since that time, funding for research on preeclampsia research has grown, from just under 40 projects about a decade ago, to over 180 preeclampsia-related research projects being funded by the NIH in 2013, with NICHD funding nearly half of those.

Areas of Preeclampsia Research for NICHD

The NICHD supports a range of research on preeclampsia at academic institutions across the country, to understand, prevent, and treat the outcomes of preeclampsia. Clinical trials are an important aspect of these efforts. For example, three recent clinical trials demonstrate the breadth of work in this area:

• Pravastatin for Prevention of Preeclampsia: a study to determine the pharmacokinetic parameters and collect preliminary safety data for pravastatin (a statin used to reduce cholesterol) when used as a prophylactic daily treatment in pregnant women at high risk for preeclampsia;
• Biological Markers of Disease in the Prediction of Preterm Delivery, Preeclampsia and Intra-Uterine Growth Restriction: A Longitudinal Study: a study to perform an early and comprehensive exploration of maternal and fetal factors that predict the subsequent development of these obstetric complications so that early medical interventions may be tested in patients at high and low risk for adverse perinatal outcomes.
• Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b): the goal of which is to find ways to identify women, who have not previously been pregnant, who will develop a problem with their pregnancies, and to use this information to improve the health of pregnant women and their fetuses in the future. This study, which has completed recruitment, focuses on such pregnancy problems as preeclampsia, preterm birth, and poor fetal growth.

Other recent studies have found that factors such as pre-pregnancy obesity put women at higher risk for the condition. Research also indicates that preeclampsia is associated with reduced blood flow to the placenta, resulting from placental cells failing to increase the size of blood vessels in the uterus during early pregnancy. In addition, researchers have identified a number of the substances the placenta produces in response to inadequate blood supply. These substances, which are released into the mother's blood stream, are thought to damage the blood vessels and thus cause the disease.

Researchers supported by the NICHD hope to identify biological markers for preeclampsia to help diagnose and predict the potential severity of the condition. For example, evidence suggests that an imbalance of two specific proteins may be a possible biomarker. Other NICHD-funded research is examining the role of autoantibodies in preeclampsia. These proteins, made by the immune system, target the body's own tissues. Understanding their function may lead to possible means of blocking their production as a way to prevent or treat preeclampsia.

Most recently, the NICHD launched a new collaborative research effort-the Human Placenta Project (HPP)-to understand the role of this vital organ in health and disease. The placenta is the least understood human organ and arguably one of the most important, influencing not just the health of a woman and her fetus during pregnancy, but the lifelong health of both. Among other goals, this project is aimed at developing new technologies for real-time assessment of placental development, applying these technologies to understand placental development and function in normal and abnormal pregnancies (such as the development of preeclampsia), and develop interventions to prevent abnormal placental development, thereby improving pregnancy outcomes.

Information provided by the Eunice Kennedy Shriver National Institute of Child Health and Human Develoment (NICHD).